Provider Demographics
NPI:1851760607
Name:KYZER, LEANNE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:MARIE
Last Name:KYZER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054
Mailing Address - Country:US
Mailing Address - Phone:803-892-5572
Mailing Address - Fax:
Practice Address - Street 1:309 BROAD ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:SC
Practice Address - Zip Code:29054-8587
Practice Address - Country:US
Practice Address - Phone:803-892-5572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist